Is Surgical Management of Brachial Plexus Tumors Safe and Effective: A Review of Clinical Experience

Sunday, May 5, 2024

2:41 PM – 2:43 PM CT

Location: Booth 745 Neuro Spotlight

Presenting Author(s)

AA

Abdel-Hameed Al-Mistarehi, MD

Post-doctoral Research Fellow
Johns Hopkins University School of Medicine
Baltimore, MD, US

Co-Author(s)

Albert Antar, NA

Medical Student
Johns Hopkins, United States
Allan Belzberg, MD, FRCSC, FAANS

Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, MD, US
Andrew M. Hersh, B.S.

Medical Student
John Hopkins Medical School
Baltimore, Maryland, United States

Co-Author(s)

Daniel Lubelski, MD

Assistant Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, MD, US

Co-Author(s)

BM

Benjamin Z. Mendelson, n/a

Medical Student
West Virginia University School of Medicine, United States
Arjun K. K. Menta, BSA, BBA (he/him/his)

Medical Student
Johns Hopkins University School of Medicine, United States
SN

Sushanth Neerumalla, n/a

Research Associate
Johns Hopkins Department of Neurosurgery, United States
AO

Arinze Ochuba, n/a

BACHELORS DEGREE IN SCIENCE NEUROSCIENCE
Johns Hopkins University School of Medicine, United States
Shahab Aldin Sattari, MD

Postdoc Research Fellow
Johns Hopkins
Nicholas Theodore, MD, MS (he/him/his)

Director, Neurosurgical Spine Center; Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States

Disclosure(s):

Abdel-Hameed Al-Mistarehi, MD: No financial relationships to disclose

Allan Belzberg, MD, FRCSC, FAANS: No financial relationships to disclose

Daniel Lubelski, MD: No financial relationships to disclose

Shahab Aldin Sattari, MD: No financial relationships to disclose

Nicholas Theodore, MD, MS: Globus Medical: Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); Harvard MedTech: Advisor (Ongoing), Consultant (Ongoing)

Introduction: Brachial plexus tumors represent a challenge for neurosurgeons due to complex anatomy, risks during surgery, and limited guidance in managing these rare tumors. We aim to share our experience in the surgical management of brachial plexus tumors.

Methods: The medical records of 123 patients diagnosed with brachial plexus tumors between July 2014 and April 2023 at Johns Hopkins Medical Institutes were retrospectively reviewed. Those who had surgical resection for brachial plexus tumors were identified. Their demographic characteristics, clinical presentations, and surgical outcomes were collected.

Results: A total of 66 patients were included [Mean±SD age, 45.06±15.12 (range, 18-77); Women, 35 (53.0%)]. Most of the tumors were schwannoma (72.7%), followed by neurofibroma (12.1%), plexiform neurofibroma with malignant transformation (10.6%), lipoma (3.1%), and synovial sarcoma (1.5%). The most common initial symptoms were palpable mass (49, 74.2%) and pain (47, 71.2%). Sensory and motor deficits were reported in 32 (48.5%) and 19 (28.8%) patients, respectively. The mean±SD duration of symptoms was 69.58±183.78 months, and the tumor was discovered as an incidental finding in 5 (7.6%) patients. The gross total resection was achieved in 51 (77.3%) patients, and the average estimated blood loss was 165.08±641.86 ml. Four patients developed postoperative complications during their hospitalization for 2.14±3.83 days, including hematoma, wound infection, and persistent sinus tachycardia, with no recorded deaths. Postoperatively, the mean follow-up duration was 34.77±37.64 months. After follow-up, 42 patients reported improvements in their preoperative pains, with complete pain relief among 26 (55.3%) patients. Among those with preoperative neurological deficits, recovery from sensory and motor deficits was documented in 20 (62.5%) and 11 (57.9%) patients, respectively. However, four patients developed new sensory deficits. Tumor recurrence was reported in 6 (9.1%) patients.

Conclusion : Brachial plexus tumors are surgically curable lesions by gross total resection with favorable outcomes, acceptable risks, minimal complications, and low incidence of tumor recurrence.